When A Health Crisis Leads to PTSD

Research shows that a traumatic health event can trigger lingering anxiety and fear.

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FRIDAY, June 22, 2012 — The patient, a 61-year-old woman, had been in intensive care for nearly a month, hooked up to a breathing machine for acute respiratory distress. Confused and disoriented, in part because of sedatives, she hallucinated that nurses hit her and attacked her grandchild.

The doctor, a psychiatrist at University of Washington School of Medicine, saw her a few months later for follow-up visits and noticed her anxiety and fear toward the hospital staff who cared for her and managed her pneumonia.

"It really started to interfere with her quality of life," said Dr. Dimitry Davydow of the Department of Psychiatry and Behavioral Sciences.

Davydow, who researches post-traumatic stress disorder resulting from medical care, says long-term anxiety and distress after a traumatic health event are more common than thought. About 1 in 5 patients in the intensive care unit have some PTSD, he says.

One in 8 heart attack survivors develop PTSD, according to a study from Columbia University Medical Center, published online in the journal PLoS ONE. According to Postpartum Support International, 1 percent to 6 percent of women experience PTSD after childbirth.

The symptoms of PTSD include repeated flashbacks to the stressful event, nightmares, trouble sleeping and anxiety, Davydow says. Other patients have trouble remembering important aspects of the traumatic event, which can cause distress. "[Symptoms are] quite common," Davydow says. "Part of the reason I began studying it is because I saw it so often in my patients."

Why Do Only Some People Develop PTSD?

Scientists at Tel Aviv University are studying brain images to uncover why some are more prone to chronic psychological stress from traumatic events. So far, researchers have identified brain activity connected to emotional experiences reported by patients, though the research on the brain's predictors of PTSD is still nascent.

Researchers agree that the severity of the incident doesn't dictate the seriousness of symptoms.

"It's more about the individual and their interaction with the stressor that brings about varying degree of severity of symptoms," Davydow says.

According to Davydow, pre-existing mental health issues such as depression and anxiety can affect recovery, as with his patient. "The stress of the illness exacerbates those pre-existing conditions," Davydow says. Traumatic injury or childhood abuse is also associated with heightened risk. He adds that having physical problems following an illness can increase chances of a stress disorder.

Patients in their 50s or younger — under the typical age for heart attack sufferers — are more likely to experience PTSD after a heart event. Donald Edmondson, assistant professor of behavioral medicine at Columbia University and a researcher of the PLoS ONE study, adds that people who feel more in danger during a medical trauma, or who feel they have less control of their health, also are more likely to experience the disorder.

PTSD Can Worsen Some Health Conditions

In the case of Davydow's patient, PTSD interfered when she avoided hospitals despite needing frequent check-ups. Eventually, her PTSD was diagnosed and she saw a therapist. Eventually, she kept the follow-up appointments she needed.

In other cases, PTSD can have serious health consequences. The PLoS ONE study by Edmondson found that PTSD after a heart attack doubled the risk of dying of a second event in one to three years, compared with people without the disorder.

Gary Dorman, 64, had a heart attack 12 years ago, but was only recently diagnosed with PTSD. Dorman woke up one morning with chest pain and excessive sweating, and was taken to two hospitals before getting treatment. His heart was seriously damaged in the delay.

Dorman says doubts and questions nagged him. What would have happened if I hadn't gone to the hospital? What if I had gotten to the better hospital sooner? What if I hadn't taken an aspirin after I felt symptoms? Playing the event over and over in his mind, he says he feels depressed and constantly vigilant about the possibility of another heart attack. Even his medications serve as a reminder of his heart condition.

Stephanie Hammar, an advocate for WomenHeart, a national coalition for women with heart disease, also experienced PTSD after a heart attack. Hammar, an athletic woman from Colorado Springs, Colo., who loves to go hiking, was shocked, along with her doctors, when she was diagnosed with heart disease at 39. When she went to doctors for nausea, she was told she had the flu or was overstressed. By the time she was 40, her heart was so badly damaged that she had five stents implanted.

Now, at 46, she often lays fearfully in bed, worried that she might again find out that she has a closed stent or blocked artery, even after getting a clean bill of health at a check-up. "I relive those moments of no one taking me seriously," Hammar says.

Previous studies have shown that the release of stress hormones such as adrenaline and cortisol into the bloodstream can increase the chances of sudden cardiac arrest or a heart attack.

Another of Edmondson's theories for why PTSD may increase mortality risk is that heart patients may avoid taking medications so as not to be reminded of their condition.

The Key is Catching PTSD Early, Researchers Say

Any traumatic event — from a breakup to losing a family member to a car accident — can cause stress and trouble sleeping, but patients should seek treatment if the symptoms persist for a month, Edmondson says.

"Exposure therapy has shown to be quite successful, and it's safe," Edmondson says. "If a person is experiencing PTSD symptoms after a month, there's no reason they shouldn't be recommended therapy." The earlier and more accurately PTSD is diagnosed, the more likely a healthcare provider can treat it. Exposure therapy involves slowly exposing a patient to a feared object or place to overcome anxiety.

Edmondson adds that changing the environment of the hospital setting could also help prevent some cases of PTSD.

"Since we do know that our patients' perception of life threat or lack of control is a big part of developing PTSD, there may be something we can do in the medical environment to decrease those feelings," Edmondson says. For example, many heart attack patients have to wait long periods in emergency rooms, which can increase their anxiety. Edmondson says lowering waiting time could help prevent PTSD.

Since he was diagnosed with PTSD, Dorman has been put on an antidepressant, which he says has helped. "Slowly, my depression has lessened, and I can take care of myself like I used to," Dorman says. He tries to stay active by gardening and fishing near his Hillsdale, N.Y. home.

Hammar has been placed on anti-anxiety medications and regularly sees a therapist. She also joined WomenHeart, where she found a group of women who could understand what she is going through.

"There are still times that I get anxious, but I can see that things have gotten better," Hammar says. "When I get into panic mode, I now have ways to calm down and focus on the things I can still do."

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